MEDICARE: INGRID BOIKE STATON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10077	AL

General Provider Information

NPI Number	:	1568756674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID BOIKE STATON

Provider Business Mailing Address
First Line	:	185 HOUSTON DR
Second Line	:
City	:	ODENVILLE
State	:	AL
Zip	:	35120-4631
Country	:	US
Telephone Number	:	205-629-5773
Fax Number	:

Provider Business Practice Location Address
First Line	:	3331 RAINBOW DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6205
Country	:	US
Telephone Number	:	256-442-7275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2011
Last Update Date	:	06/06/2011

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Directions to “ INGRID BOIKE STATON ” Practice Location

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